Murray Watt (Queensland, Australian Labor Party, Shadow Minister for Northern Australia) Share this | Hansard source

Labor supports the passage of the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021, but I'd like to foreshadow that at the end of my remarks I'll be moving a second reading amendment. I think all Australians would recognise that administration of the aged-care system in this country has been one of this government's greatest failures, and that is saying something. This bill will make urgent and needed amendments to the Aged Care Act to implement three measures in response to the Royal Commission into Aged Care Quality and Safety, and, in the case of restrictive practices, in response to the Independent review of legislation provisions governing the use of restraint in residential aged care. It needs to be made clear that the government's response to the aged-care royal commission falls far short of where it needs to be in terms of solving a number of key issues in the aged-care system and fails to deliver enduring changes and reform for the long term.

I will start with the first key change in the legislation: the overuse of restraints in aged care. Substandard care can take many forms, and the royal commission concluded that 30 per cent of older people in aged care, almost one in three, have experienced some form of substandard care. The royal commission specifically heard about the excessive use of physical and chemical restraints in residential aged care, which robs older Australians of their dignity and autonomy in their final months. Older people with mental health issues, particularly those suffering from the later stages of dementia, are often heavily medicated or physically restrained. In the final three months of 2019-20, residential aged-care services made 24,681 reports of intent to restrain and 62,800 reports of physical restraint devices. Far too many people experience the aged-care system as uncaring, unkind and even inhumane in its response to them and their needs.

This bill will make a number of important changes in regard to restraints and restrictive practices. It will clarify the definition of 'restrictive practice' in the Aged Care Act so that it is in line with the NDIS definition and ensure that all restrictive practices that limit the freedom of movement of an aged-care resident are included. It will expand the Aged Care Quality and Safety Commissioner's ability to respond to breaches of approved aged-care providers' responsibilities in relation to restrictive practices, with new abilities to issue written notices and make applications for civil penalty orders. It will provide that the quality care principles set out clearly when an aged-care provider is able to consider the use of restrictive practices—importantly, only ever as a last resort. While it is disappointing to see the royal commission's recommendation around the introduction of independent expert approval for the use of restrictive practices, this bill will help prevent the overuse of restraints and restrictive practices in aged care.

The second key change in this legislation is the introduction of assurance reviews. The introduction of assurance reviews, while not specifically recommended by the aged-care royal commission, is welcome, if they do as described and increase the effectiveness, efficiency and transparency of the home-care system. While this move is welcome, it is disappointing that the government hasn't followed more closely the recommendations from the aged-care royal commission to increase transparency and accountability measures. We know there are many aged-care providers doing amazing work who are dedicated to the health and wellbeing of those in their care. That's not to mention, of course, the incredible work that aged-care workers themselves perform. But we also know that there are far too many aged-care providers who are not doing the right thing. While the government likes to appear to be tough on bad providers, when you dive into the detail of its response to the royal commission, so often it turns out that they're letting those providers—the bad ones—do what they want. These assurance reviews are fine, but why not make the reports and recommendations that come out of these reviews all public? Why leave this up to the Secretary of the Department of Health? This is the same person that is in charge of system governance. Could there ever be an opportunity when it wouldn't be in their interest to release one of these reviews? Labor is committed to doing things very differently here. We want to see a transparent and accountable sector, a sector where bad providers are not allowed to run riot and do what they please, as this government has let them do for so long.

The third key change in the legislation is replacing the Aged Care Financing Authority. The government agreed to establish an advisory group to replace the authority, which will commence operations from July 2021, to ensure the government continues to receive advice on financing issues of the aged-care sector. A new advisory body will be established to provide advice to government on aged-care financing issues.

This bill and its changes are welcome. There is no doubt that the changes to rules around the use of restraints and restrictive practices are needed. There is no doubt that transparency and accountability in the aged-care sector need to be dramatically improved. But why is this the only legislative action the government is taking right now in response to the damning and wide-ranging findings of the aged-care royal commission? Why is this the only bill we're seeing, months after the royal commission handed down its final report? Where is the sense of urgency on aged care from the Morrison government? They have received 21 expert reports into the state of aged care in Australia since 2013, reports that largely foreshadowed the shocking findings of the royal commission's eight-volume report, which told us how bad the crisis in aged care is. Given just how shocking and damning and completely unacceptable those findings were, where is the sense of urgency to fix the problems identified? Where is the sense of urgency to improve the level of care that older Australians are receiving? But maybe we shouldn't be surprised. Maybe it doesn't matter how bad things are in aged care for the Morrison government, because they like to take things slowly and take things easy.

The Morrison government has neglected the aged-care sector for eight years. If you need any further proof of that, just look at the title of the royal commission report: Neglect. That is the way the royal commission summarised the work of this government over eight long years. For eight years this government has neglected older Australians who have received aged-care services. It's neglected hardworking and dedicated aged-care workers for eight years. Don't just take my word for it. The royal commission described the government's approach to aged care in its final report, where it said:

At times in this inquiry, it has felt like the Government's main consideration was what was the minimum commitment it could get away with, rather than what should be done to sustain the aged care system so that it is enabled to deliver high quality and safe care.

In fact, that really does sum up the approach of this government to so many issues—in particular, aged care. What is the bare minimum they can get away with? This is an absolutely damning finding from the royal commission. The crisis in aged care has been brewing for years. The 21 expert reports that are gathering dust on the minister's desk warned the government that this was coming, but they chose to neglect the aged-care system for eight long years. It is a national disgrace, and the ministers responsible should be ashamed for the part they have played in this crisis.

Despite the royal commission's damning words, this government's approach still seems to be to do the minimum it can get away with. At the end of the day, this is the Prime Minister's crisis. It's happened on his watch. When Mr Morrison was the Treasurer, he even cut funding to the sector by $1.7 billion. How can anyone trust Mr Morrison to fix the aged-care crisis? How can older Australians trust Mr Morrison? How can their families trust Mr Morrison? How can aged-care workers trust Mr Morrison?

The aged-care royal commission graphically highlighted the failures of the government, failures that have happened on their watch and while they have failed to watch, failures including maggots in the wounds of residents and failures including the two-thirds of residents who are malnourished or at risk of malnourishment—that is, two-thirds of residents are literally starving in the care of their own government. How can anyone stand by and let that happen for eight long years? How can the government sit there and still refuse to show any real urgency while this is happening? They should be ashamed.

The Morrison government have failed to listen to Australians in aged care, to their families and to the workers in the system when they raised the alarm bells about the absolutely dire conditions in some residential homes. They've failed to listen to families about the impact on their lives of having to wait years to get high-care needs home-care packages. They've failed to listen to workers about being exhausted, about being overworked, about being under-resourced, about being underpaid and about being undervalued.

Who can forget the performance of the aged-care minister at the recent Senate estimates, where, yet again, he refused to back in a pay rise for aged-care workers? What a way to treat the people that we depend upon to provide services and care to the elderly in our community—our grandparents, our parents, our loved ones. Of course, this minister, along with his predecessors, failed to listen to those 21 expert reports that the government have received on the issues.

If you ask anyone to describe the government's record on aged care in one word, they will say the same thing: neglect. But they still aren't listening, not even to the royal commission that they were forced into calling. They haven't learned their lesson, because their response to the aged-care royal commission is, as the royal commission found, the bare minimum they think they can get away with. Not a single issue is actually fixed.

The Morrison government's response to the aged-care royal commission falls far short of where it needed to be. It failed to deliver enduring improvement and reforms for the long run. They've fobbed off, delayed or outright rejected key recommendations. Of the 148 recommendations, over half are not being implemented or aren't being implemented properly. So often in their response, the government claims to have accepted a recommendation. But, when you actually look at the detail, times are pushed back, sometimes by years. Key sections of recommendations are often excluded. Sometimes they say they've accepted a recommendation, but their response doesn't even pretend to match it. That is a very strange definition of the word 'accept', which is what the government claim to have done. It's the same old behaviour we've come to expect from a government that says one thing and does another—that does the bare minimum to deal with the aged-care system. This is a government that makes a big announcement but never follows through on detail—on aged care and so many other things.

The government's response to the royal commission falls flat in five major areas in particular. Firstly, nothing will change without reform to the aged-care workforce. There was nothing to improve wages for overstretched, undervalued aged-care workers. Secondly, the government is gifting $3.2 billion to providers via a basic daily fee increase, with no strings attached to ensure it goes to actual care or better food and not management bonuses or a new office fit-out. Thirdly, the government has failed to clear the home-care package waitlist of 100,000 people. Only 80,000 packages were included in the budget over the next two years, and thousands join the waitlist every year. The maths don't add up. This government is not even going to clear the current backlog before a single new person joins that waiting list. Fourthly, the government has ignored the recommendation to require a nurse to be on duty 24/7 in residential care. This is core to improving clinical care for frail Australians. And, fifthly, the government's promise of mandatory care minutes for each resident is also full of holes. It doesn't meet the royal commission recommendation, and we now know that cleaning and some admin will be included as care. As important as those roles are, it doesn't satisfy what the royal commission was talking about. Why bother calling the royal commission and then ignore so many of its recommendations? Why bother calling the royal commission and not fix the crisis it identifies?

And that's before we get to the impact of COVID on aged care. Recently we have seen the government's neglect of aged-care residents and workers play out yet again, with potentially deadly consequences. Because of this government's failures in quarantine and its failures in the vaccine rollout, we again saw COVID-19 cases in aged care. People are angry about it, and they have every right to be so. Last year we lost 685 residents in aged care to COVID-19. This government left the door open to this tragedy happening again. What residents and staff went through last year was nothing less than absolutely traumatic. Residents lost their friends and their companions.

Just this week we found out that still only 30 per cent of aged-care workers have had their first vaccination. We found out yesterday that about 15 per cent of aged-care workers have been fully vaccinated. These people were supposed to be fully vaccinated by the end of March. They're the government's top priority, and only 15 per cent of people have been fully vaccinated. If you listen to the government talk about it, you'd be unable to tell. The Prime Minister says that the vaccine rollout is not a race. The aged-care minister says he's comfortable with the speed of the rollout. Neither the health minister nor the aged-care minister can seem to get their numbers straight. Unless the government acknowledge their faults and their mistakes in aged care, how is anyone supposed to trust them to fix it? Right now there is no plan from this government, and no plan and no targets mean no urgency.

In conclusion, what is absolutely clear to me is that, wherever you look now, the story of aged care is: don't send the Liberal and National parties on a job you trust only the Labor Party to do. The last eight years of neglect by this government have shown another three years won't make a difference. To summarise, while we welcome the changes in this legislation, the government response to the royal commission falls far short of where it needs to be. My second reading amendment notes, among other things, the government's failures in relation to aged care. I move:

At the end of the motion, add: ", but the Senate:

(a) notes the:

  (i) systemic, ongoing failures in Australia's aged care system as evidenced by the Royal Commission into Aged Care Quality and Safety, including, but not limited to, the use of restrictive practices and the lack of transparency and accountability in aged care,

  (ii) inadequacy of the Government's response to the Royal Commission into Aged Care Quality and Safety, including delayed and diminished legislative action on key issues and recommendations, including, but not limited to:

(A) the malnutrition crisis, with two thirds of aged care residents either malnourished or at risk of malnourishment,

(B) the Home Care Package waitlist,

(C) improved pay and recognition of hardworking and dedicated workers,

(D) improved transparency and accountability around public funds,

(E) mandatory care minutes, and

(F) ensuring a registered nurse is onsite at residential facilities 24 hours a day, and

  (iii) Government's failures in protecting aged care residents and workers due to their poor management of COVID-19 outbreaks in residential aged care, and

(b) calls on the Government to explain, as a matter of urgency, their plan to fully vaccinate aged care workers and keep aged care residents safe".